Abdominal Physical Examination

Abdominal Physical Examination I. Theoretical Concepts Abdominal examination is carried out on the abdomen using the Inspection, Auscultation, Percussion, Palpation (IAPP) technique. II. Objective 1. Know the shape and movements of the stomach 2. Listen to the sounds of intestinal peristalsis 3. Examine the area of tenderness, organs in the abdominal cavity, lumps in the stomach Physical examination of the abdomen is divided into 4 quadrants with techniques: 1. Inspection: to determine the shape, condition and movements of the abdomen. a. Arrange good lighting b. The correct position is to lie on your back with your arms on both sides and slightly bent. A small pillow is placed under the knees to support and relax the abdominal muscles c. Open the abdomen from the xiphoid process to the symphysis pubis d. Observe the general shape of the stomach, skin color, surface contour of the stomach, presence of retraction, protrusion, asymmetry, scar tissue, striae, etc. e. Note the position, shape, color and presence of inflammation or discharge of the umbilicus Umbilicus:Look at the position, shape, color, signs of inflammation, or a protruding mass. Normally the umbilicus is flat or hemispherically concave. The color is the same as the surrounding skin. An umbilicus that sticks out usually indicates distension. Like a hernia that causes the umbilicus to protrude upwards. f. Observe the skin movements on the abdomen during inspiration and expiration 2. Auscultation: to listen to abdominal sounds, namely bowel sounds/morility (peristalsis). a. Warm the diaphragm and bell of the stethoscope b. Place the diaphragm side of the stethoscope above the lower right quadrant in the cecum area. Apply very light pressure. Ask the client not to speak. It may take 5 minutes of continuous listening before the examiner determines the absence of bowel sounds c. Listen for bowel sounds and note their frequency and characteristics d. If bowel sounds are not easily heard, continue the systematic examination, listening to each quadrant of the abdomen e. Note bowel sounds as normal or audible, absent, hyperactive and hypoactive Normally intestinal peristalsis occurs irregularly 5-35 x/minute. The absence of sounds indicates intestinal obstruction, ileus or peritonitis. When bowel sounds that are more than normal occur indicate intestinal inflammation, anxiety, diarrhea, bleeding. f. Place the bell/hood of the stethoscope over the aorta, renal arteries, iliac arteries and femoral arteries g. Place the bell in the preumbilical area/around the center to listen for venous murmurs (rarely heard) 3. Percussion: carried out to determine the location of organs, masses, air, fluid in the abdomen. Percussion in each quadrant to assess the tympanic area and deafness. a. Start percussion from the lower left quadrant then move clockwise (from the client's perspective) b. Pay attention to the client's reaction and note down any complaints c. Perform percussion on the tympanic and dull areas 4. Palpation: to detect areas of tenderness in the abdomen or the presence of a mass. Each quadrant of the abdomen is examined systematically. a. Light palpation - Lightly palpate the abdomen over each quadrant, avoiding areas that have previously been problem spots - Place your hand lightly on your abdomen with your fingers extended and pressed together - Place the client's hand lightly on the examiner's hand to reduce sensationamused - With the surface of the palm of your fingers, press slightly to a depth of 1 cm - Palpate to detect areas of pain, abnormal tension or masses - During palpation, observe the client's face for signs of discomfort If pain is found, test for pain relief: press deeply then release quickly to detect whether pain occurs by releasing the hand - Palpate around the umbilicus and umbilical ring b. Deep Palpation - Use the bimanual palpation method - Press the abdominal wall about 4-5 cm - Note the presence of masses and underlying organ structures. If a mass is present, note its size, location, mobility, contour and stiffness c. Liver Palpation - The examiner stands to the right of the client - Place the examiner's left hand on the client's right posterior thoracic wall approximately at the 11th or 12th rib - Press your left hand upwards, lifting the chest wall slightly - Place your right hand on the lower border of your right side ribs - When the patient exhales, apply pressure 4-5 cm downwards on the lower border of the rib cage - Keep the examiner's hand in position and ask the patient to inhale deeply - While the patient is inhaling, the liver borders move against the examiner's hand, which normally feels a regular contour - If the liver is enlarged, then palpate the lower border of the right rib. Note the enlargement and state how many cm the enlargement occurs at the lower border of the rib cage d. Palpation of the Spleen - When the examiner is standing on the client's right side, hold it crosswise with the examiner's left hand and place it under the client and above the costovertebral angle. Press up with your left hand - Place the right palm with fingers on the abdomen below the left costal edge - Press the fingertips towards the spleen then ask the client to take a deep breath - Palpate the edge of the spleen as it moves downward toward the examiner's hand Palpate the client for ascites - To assess the ascitic fluid surge, ask the client or another caregiver to assist as this procedure requires three hands - Instruct the client to lie on his back - Ask the client or another nurse to press with the edge of the hand and upper arm exactly along the vertical midline of the abdomen - Place the examiner's hand on each side of the abdomen and tap sharply on one side with the tip of the finger - Feel the fluid wave impulses with the fingertips of the other hand f. Kidney Palpation - When palpating the right kidney, place your left hand under your pelvis and elevate the kidney anteriorly - Place the right hand on the anterior abdominal wall at the midclavicular line at the lower edge of the costal border - Press the right hand directly upward while the patient takes a deep breath. In normal adults, the kidneys are not palpable, but in very thin people, the lower part of the right kidney can be felt - If the kidneys are palpable, feel the contour (shape), size, and any tenderness - To palpate the left kidney, do it on the opposite side of the patient's body and place your left hand under the pelvis then do the same as when palpating the right kidney. III. Indication A physical examination of the abdomen is carried out on each patient to determine abdominal abnormalities